NPIMap

Organization Active NPI

Proliance Surgeons, Inc., P.S.

Doing business as Proliance Orthopedic Associates

  • Orthopaedic Surgery Physician
  • Auburn, WA
National Provider Identifier
1417512021
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
PROLIANCE SURGEONS, INC., P.S.
Doing business as
Proliance Orthopedic Associates
Practice address
1620 Lake Tapps Pkwy SE Ste 115
Auburn, WA 98092-8376
Phone
(253) 246-2860
Fax
(253) 246-2861
NPI assigned
May 8, 2019
Last updated
May 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Laura Kleisle
Title
Chief Risk Officer
Phone
(206) 838-2590

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X Primary
Orthopaedic Hand Surgery Physician 207XS0106X
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X
Orthopaedic Surgery of the Spine Physician 207XS0117X
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X
Orthopaedic Trauma Physician 207XX0801X
Multi-Specialty Clinic/Center 261QM1300X
Surgical Physician Assistant 363AS0400X
Nurse Practitioner 363L00000X

Addresses

Primary practice location

1620 Lake Tapps Pkwy SE Ste 115
Auburn, WA 98092-8376

Mailing address

4011 Talbot Rd S Ste 300
Renton, WA 98055-5791
Phone (425) 656-5060

Other names 1

  • Proliance Orthopedic Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031119000128 WA Part B Supplier - Clinic/Group Practice 8527972900 Receives reassigned benefits from 781 practitioners
This NPI is an additional NPI on the enrollment
O20200217000610 WA DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Sports MedicineDME Supplier - Nurse PractitionerDME Supplier - Multi-Specialty - PhysicianDME Supplier - Physician Assistant 8527972900 Practice locations: Auburn, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1417512021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4011 TALBOT RD S STE 300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555791",
            "telephone_number": "425-656-5060",
            "fax_number": "425-656-5047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 LAKE TAPPS PKWY SE STE 115",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980928376",
            "telephone_number": "253-246-2860",
            "fax_number": "253-246-2861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-08",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A",
        "authorized_official_last_name": "KLEISLE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "CHIEF RISK OFFICER",
        "authorized_official_telephone_number": "206-838-2590",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0801X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proliance Orthopedic Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Proliance Orthopedic Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Auburn, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.